NPI | 1750374104 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C53189) |
Additional Taxonomies | 103T00000X Psychologist (Licence: OH 35071066) |
Enumeration Date | 2005-08-31 |
Last Update Date | 2023-11-03 |